General Questions

At about 6 months, the two lower front teeth (central incisors) will erupt, followed shortly by the two upper central incisors.

The remainder of the baby teeth appear during the next 18 to 24 months, but not necessarily in an orderly sequence from front to back.

At 2 to 3 years, all of these 20 primary teeth should be present. Permanent teeth will begin to erupt into the mouth around age 6. With the exception of wisdom teeth, all adult teeth are present by ages 12-14. The first adult teeth to erupt are the permanent molars (behind the existing baby molars) and the lower central incisors.

The first tooth normally erupts between the ages of 6 to 12 months; at that time, gums become sore, tender and sometimes irritable until the age of 3.

Rubbing sore gums gently with the back of a cold spoon or a cold, wet cloth helps sooth the gums. Teething rings work well, but avoid teething biscuits – they contain sugar which is not good for baby teeth.

Usually, the space will close in the next few years as the other front teeth erupt. Your pediatric dentist can determine whether there is cause for concern.

Four things are necessary for cavities to form – a tooth, bacteria, sugars or other carbohydrates and time.

Dental plaque is a thin, sticky, colorless deposit of bacteria that constantly forms on everyone’s teeth. When you eat, the sugars in your food cause the bacteria in plaque to produce acids that attack the tooth enamel. With time and repeated acid attacks, the enamel breaks down and a cavity forms.

Care & Dental Hygiene

Brush teeth at least twice a day – after breakfast and before bed. Use a toothbrush with a soft bristled head. Replace the brush every 3-4 months.

Place the brush at a 45-degree angle and brush in a circular motion. We recommend using a thin smear of fluoridated toothpaste for children less than 3 years of age, and a pea-sized amount of fluoridated toothpaste for children over age 3. You can watch a tutorial about brushing your child’s teeth led by Chestnut Dental’s Dr. Anne Hertzberg here.

Start using toothpaste once your child has eruption of her or his first tooth. We recommend using fluoride toothpaste twice a day.

A thin smear of fluoridated toothpaste can be used for children under 3 years of age, and a pea-size amount of fluoridated toothpaste for children 3 years and older. Try to encourage your child to spit out the toothpaste, with minimal-to-no rinsing.

Fluoride has been shown to dramatically decrease a person’s chances of getting cavities by making teeth stronger.

There are both topical and systemic sources of this exposure. Topical exposure includes toothpaste, rinses and gels. Our pediatric dentists will work with you to determine the appropriate topical fluoride exposure for your child.

Systemic exposure includes fluoride from community water, food, beverages and fluoride supplements. If you have a water filtration system, filters like Brita do not remove fluoride; reverse osmosis and distillation leave fluoride intact. Bottled water, however, contains variable amounts of fluoride – this can range from low levels of fluoride to none at all. Many food and beverages made with water, including infant formula, can contain varying levels of fluoride. If you have well water, you should test fluoride levels every three years with water test kits that are available through your health or water department.

Early childhood caries is a pattern of rapid decay that is often – but not exclusively – associated with prolonged nursing. It happens when a child goes to sleep while breast-feeding and/or bottle-feeding. During sleep, the flow of saliva is reduced and the natural self-cleansing action of the mouth is diminished. When an infant falls asleep while feeding, remnants of the milk or formula are left in the mouth to nourish bacteria – and less saliva is available to neutralize that bacteria. For this reason, it’s important to avoid nursing children to sleep or putting anything other than water in their bedtime bottles. Encourage your child to drink from a cup as she/he approaches her or his 1st birthday. Your child should be weaned from the bottle at 12-14 months of age. Do not place juice or flavored milk in a sippy cup or bottle. Limit frequency of exposure to juice – 1 cup a day at meal time only. Cutting juice with water only decreases the calories; it does not decrease cavity risk.

Caregivers can transfer cavity-causing bacteria to children – thus, it is important to minimize saliva-sharing behavior and also to schedule routine dental visits for caregivers. Keep your child’s diet as healthy as possible and limit the frequency of exposure to fermentable carbohydrates (such as sweets, crackers and even fruits). Schedule your child’s first visit to the pediatric dentist by their 1st birthday.

Sucking on fingers, pacifiers or other objects when children are young is completely normal and can provide a sense of security. Most children naturally outgrow this habit between 2 and 4 years old.

Thumb- and pacifier-sucking habits that go on for a long period of time can create crowded, crooked teeth or bite problems.

Most children stop these habits on their own. However, if children are still sucking their thumbs or fingers when the permanent teeth erupt, behavioral modification techniques or an intraoral appliance may be recommended by your pediatric dentist or orthodontist.

A mouthguard should be a top priority on your child’s list of sports equipment. Athletic mouth protectors (or mouthguards) are made of soft plastic and fit comfortably to the shape of the upper teeth. They protect a child’s teeth, lips, cheeks and gums from sports-related injuries.

Any mouthguard works better than no mouthguard, but a custom-fitted mouthguard fitted by your pediatric dentist is your child’s best protection against sports-related injuries.

Common Problems

To comfort your child, rinse her/his mouth with warm salt water; if there is swelling, apply a cold compress or ice wrapped in a cloth to your child’s face. Do not apply heat to the sore area or administer aspirin, but you may give your child acetaminophen for pain. See us as soon as possible.

First of all, remain calm. If possible, find the tooth and hold it by the crown rather than the root. Replace the tooth in the socket and hold it there with clean gauze or a washcloth.

If you can’t put the tooth back in the socket, place the tooth in a clean container with milk or Save-a-Tooth® solution, and bring your child and the glass immediately to your pediatric dentist. The faster you act, the better your chances of saving the tooth.

Primary (or “baby”) teeth are important for many reasons. Not only do they help children speak clearly and chew naturally, they also aid in forming a path that permanent teeth can follow when they are ready to erupt. Some primary teeth are necessary until a child is 12 years old or longer. Pain, infection of the gums and jaws, impairment of general health and premature loss of teeth are just a few of the problems that can happen when baby teeth are neglected.

Additionally, because tooth decay is really an infection and will spread, decay on baby teeth can cause decay on permanent teeth. Proper care of baby teeth is instrumental in enhancing and safeguarding the health of your child.

Pediatric Dentistry

Kids need and deserve to have a dental experience that’s friendly, tender and anything but scary. That’s why our pediatric dental practice is made up of a team of dentists who have completed two years of advanced education after a four-year dental school curriculum. They have all been certified by the American Board of Pediatric Dentistry, which indicates their devotion to treating children. It also indicates their expertise in the unique needs of infants, children and adolescents, including those with special health needs.

Sealants are clear or shaded plastic applied to the teeth to help keep them cavity-free. Sealants fill in the grooved and pitted surfaces of the teeth, which are hard to clean, and shut out food particles that could get caught and cause cavities. Fast and comfortable to apply, sealants can effectively protect teeth for many years.

With contemporary safeguards – such as lead aprons and high-speed film – the amount of radiation received in a traditional dental X-ray examination is extremely small. In addition, Chestnut Dental now takes all of our X-rays digitally, which has many benefits. The X-ray results are ready almost instantly – and, more importantly, the amount of radiation exposure for each patient is significantly reduced and the process is far more environmentally-friendly.

Even though there is very little risk, pediatric dentists are particularly careful to minimize the exposure of child patients to radiation. On the whole, dental X-rays represent a far smaller risk than an undetected and untreated dental problem.